Patient Forms

The information we collect on these forms is important and helps us be better prepared to care for you. Thank you for taking the time to complete them ahead of your appointment.

New patients will need to complete the forms in the ALL NEW PATIENTS group. In addition to these, hormone, pediatric, and mental health patients will need to complete the forms in these groups.

You can print the forms at home, fill them out, and either scan and email them to us or bring them with you to your appointment,

Email completed forms to office@allinfamilymed.com

 

ALL NEW PATIENTS

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Please complete all forms in this group.

• Adult Intake Form
• Consent / HIPAA
• Routine Screening Questionnaire
• Controlled Substance Policy

If you would prefer to complete the New Patient Forms later, you can use this Initial Appointment Minimum Information form for now. This is the basic information we need before we can schedule your appointment. We will still need all of the forms above completed before you see your provider.

• Initial Appointment Minimum Information

 

NEW HORMONE PATIENTS

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Please complete the form appropriate for your gender.

• Female Health Assessment
• Male Health Assessment

 

NEW PEDIATRIC PATIENTS

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• Pediatric Intake

 

NEW MENTAL HEALTH PATIENTS

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Please complete all forms in this group.

• Adult Psychiatry Clinic Intake
• Psychiatric Medication List

For Ketamine Therapy Patients

• Ketamine for Depression Patient Information
• Ketamine Therapy Informed Consent
• Ketamine Therapy Consent for Repeat Treaments